Organization
CHILDREN1ST
Active
Organization
CHILDREN1ST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACEY LYNNE FOWL MASTERS SPECIAL ED (DEVELOPMENTAL INTERVENTIONIST)
(270) 300-2044
Entity
Organization
Contact information
Practice address
104 HOLIDAY COURT, ELIZABETHTOWN, KY 42701-8809
(270) 300-2044
(270) 360-3271
Mailing address
104 HOLIDAY CT, ELIZABETHTOWN, KY 42701-6490
(270) 300-2044
(270) 360-3271
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
EDSP 71846
KY
Other
Enumeration date
05/17/2016
Last updated
05/17/2016
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